Head Injuries May Trigger Dementia, Madness

Head Injuries May Trigger Dementia, Madness

They call it "the pop." It's that moment when thousands of fans are jolted screaming to their feet, an involuntary response to some act of unbelievable strength, astounding agility or brute violence. On the football field, the hockey rink, the basketball court - the pop is the product. Nowhere is it more essential or more lucrative than in pro wrestling. And in the history of the ring, only few could make a crowd pop like Chris Benoit.

For seven years, the Montreal-born, Edmonton-raised "Canadian Crippler" travelled the world as one of the stars of World Wrestling Entertainment. With a superhero physique, Benoit could throw his body around like a gymnast and lift 250-lb. men as if they were toddlers. Night after night he would cap his performance with his signature finale: the diving head-butt. He'd climb to the top turnbuckle, and leap more than 10 feet through the air, crashing down and driving his head into some hapless opponent below.

Of course, wrestling is a circus act - a "work" as they call it. No one's really supposed to get hurt. But when you pull that stunt as many as 200 nights a year, mistakes happen, and pro wrestling history is littered with men who destroyed their bodies in pursuit of the pop. In 2001, Benoit broke his neck during a match and narrowly avoided permanent paralysis. Over the years, friends and colleagues say, he suffered his share of concussions - though apparently none were ever reported to the WWE. He was quiet and intense, and never complained. Those who knew him best say he was an entertainer who loved his job, and showed a special generosity to disabled kids. But to the rest of the world, Chris Benoit will forever be remembered as a murderer.

Sometime on the weekend of June 23, 2007, Benoit strangled his wife, Nancy, in their suburban Atlanta home. It appears he then smothered his mentally handicapped, seven-year-old son Daniel. He then placed Bibles next to their bodies, and sometime later he went into his mirrored home gym, and hung himself from a piece of exercise equipment. He left no note. The immediate speculation in the media pinned the blame on steroids - toxicology results showed Benoit had been taking synthetic testosterone, and in his home police found vast quantities of other chemicals to help maintain his superhuman musculature. Benoit also tested positive for a powerful narcotic painkiller, and the anti-anxiety drug Xanax. That was enough for most: drug-addled muscleman kills family in a fit of steroid-fuelled rage. End of story.

But a group of neurologists in the U.S. saw the reports of the Benoit murder/suicide and suspected there might be another explanation. The doctors, aligned with the non-profit Sports Legacy Institute, had already embarked on an investigation of concussion damage in retired athletes, and had seen a handful of cases of former pro football players who died young after suffering mental breakdowns in their 30s and 40s. Their brains showed microscopic evidence of serious head injuries, most likely suffered over years on the playing field, and they suspected that Benoit might have suffered a similar fate. Sure enough, when they examined Benoit's tissue they found a 40-year-old brain that looked like that of an 85-year-old in advanced stages of Alzheimer's disease, says Dr. Bennet Omalu, who performed the examination.

"The damage we saw does not show up on MRI or CT scans, and it doesn't show on naked-eye examinations, and I believe this is why this disease has been missed for so long," Omalu says. "We have always believed that people generally recover from concussions. But what we're finding is that some people may never really recover from recurrent concussions, just like people don't really recover from exposure to asbestos. The damage is in your tissue."

The U.S. Congress is planning committee hearings into health and safety issues in the WWE, based largely on the long trail of performers who, like Benoit, died young with a cocktail of drugs coursing through their veins. But if Omalu is right about what triggered Chris Benoit's killing spree, the stakes have been raised considerably. It means there are almost certainly others out there, suffering in silence, on a long dangerous spiral into psychosis. More and more, neurologists say it's time to admit that concussions are not just an occupational hazard. They are a matter of life and death - not only for the sufferer, but for everyone around them as well.

Justin Strzelczyk was a mountain of a man, by any measure. He was six feet six inches tall, and weighed close to 300 lb. Between 1990 and 1998 he was an immovable presence on the offensive line of the NFL's Pittsburgh Steelers. He survived almost a decade in one of football's most physically punishing jobs. After he retired in 1998, he opened a garage near Pittsburgh where he made custom hubcaps. He rode his Harley, played his banjo and partied hard - food, booze and a little pot were among his favourite vices.

Sometime in 2003, however, family and friends began to notice major changes in him. Once easygoing, he now seemed quickly agitated. His sister recalled that in conversation he would fixate on certain topics and refuse to drop them. Another friend, a family doctor named Jim Doran, told the Washington Post about a conversation in the fall of 2004 when Strzelczyk rambled uncontrollably from topic to topic. He'd lost weight, and finally confided that he'd been having trouble sleeping and was hearing voices in his head. He said he believed the government was after him, and that the end of the world was coming. Repeatedly, he asked passersby if they believed in God. Doran tried to convince his friend to go with him to the hospital, but he grew suspicious and irritable. Finally, he told Doran he was going to church to pray.

At 2 a.m. on Sept. 30, 2004, Strzelczyk climbed into his pickup truck outside Pittsburgh and began driving north. A few hours later, police received a call that someone in a truck had bumped two cars and was speeding and weaving erratically on the New York State Thruway. Not far from Rochester, police began chasing Strzelczyk's truck. For 40 miles they tailed him at speeds nearing 90 miles an hour, before he pulled into oncoming traffic. For four more miles, cars squealed and screeched out of the way, until finally Justin took dead aim at a tanker truck and smashed into it, head-on. The driver of the truck was miraculously unhurt. Strzelczyk was ejected roughly 80 yards from the crash scene, and was killed instantly. He was 36. Tests revealed he had no drugs or alcohol in his system.

The fiery crash was soon forgotten: just another human freak gone supernova. It wasn't until earlier this year, almost three years after his death, that someone would take a closer look at the brain tissue harvested during Strzelczyk's autopsy. But by the time Dr. Omalu, then an instructor of neuropathology with the University of Pittsburgh School of Medicine, peered through the microscope, he already knew what to expect.

Like an investigator on the heels of a serial killer, he'd seen it before: the neurofibrillary tangles, the snaking remnants of dead neurons, and plaques made up of TAU proteins. It was there in the brain tissue of Mike Webster, an All-Pro centre who suffered paranoid delusions after retirement, and was homeless when he died of heart failure in 2002. It was the same with Terry Long, another former Steelers' lineman who behaved erratically for several years before he killed himself by drinking anti-freeze in the summer of 2005. And then there was Andre Waters, a hard-hitting safety with the Philadelphia Eagles from 1984 to 1995, who had been an outgoing and respected college coach after his retirement, until he slipped into a deep depression and shot himself in the head in his home near Tampa, Fla., last Nov. 20 at the age of 44.

It was these findings that led Omalu and fellow neurologists Dr. Julian Bailes of the West Virginia University School of Medicine and Dr. Robert Cantu of Brigham and Women's Hospital in Boston to help found the Sports Legacy Institute with a Harvard-educated former pro wrestler named Chris Nowinski. Their mission now is to advance their research and to publicize the untold dangers of concussions. As intriguing as their results are, though, they barely begin to answer all the mysteries that remain.

Doctors can tell you that concussion occurs when a person is hit with enough force to snap the head violently. The brain is suspended in a sac of fluid called the dura, and when the brain bounces within that protective cavity, it causes blood vessels to tear. The resulting swelling can cause a broad array of symptoms: headache, dizziness, ringing in the ears, disorientation, slurred speech. In severe cases, the victim might lose consciousness, or even temporarily lose their eyesight. The only known treatment is rest, and most times, doctors say, symptoms resolve spontaneously, as the brain clears the swelling. In rare cases, victims might suffer from post-concussion syndrome in which symptoms refuse to subside, or return with a vengeance when patients physically exert themselves.

It's becoming increasingly clear, however, that even this doesn't fully capture the risks unleashed by blunt force shots to the head. For close to a century, doctors have known about dementia pugilistica, or chronic traumatic encephalopathy, but it was long thought to be the exclusive domain of boxers, and no one is absolutely sure what triggers it. Doctors suspect that when the brain suffers a concussion it temporarily loses its ability to metabolize natural proteins. When properly rested, the brain usually recovers back to normal, says Bailes. But when some people suffer repeated severe concussions, or receive a secondary blow while the brain is still recovering, then the brain's cellular structure can be permanently damaged. Proteins begin to accumulate, forming plaques that interfere with normal brain function. The result is a gradual cognitive decline that can take place over years - memory loss, depression, personality changes. And if the damage is extensive and occurs in parts of the brain regulating judgment and emotional control, the results can be truly horrific, as in the cases of Strzelczyk, Benoit and others, Bailes says. "If you look at the brain of a boxer in an autopsy it looks like Swiss cheese," says Dr. Charles Tator, a professor of neurosurgery at the University of Toronto, and one of the world's top experts in sports concussions. "It literally has holes in it, and now we recognize these as Alzheimer-type plaques associated with trauma."

The more new information comes to light, the more the stakes seem to rise. Last year, the National Center for Injury Prevention released a study estimating as many as 47 per cent of high school football players suffer concussions each season. A survey by the same organization found 35 per cent of players said they had sustained more than one concussion in the same season. New research out of Ohio State University shows that young girls are even more susceptible to concussion damage than boys, and are slower to heal. Female high school soccer players are second only to football players in terms of concussion risk. Cases of CTE have "already been flagged and observed in football players, boxers, soccer players, all kinds of sports," Tator says. "What we don't know is how many concussions you need to have for this progressive deterioration to take place, or what percentage of people it affects. The new twist on this is the suggestion that trauma-related dementia can lead to suicide and even homicide in the case of Benoit."

The spectre of unexplained and progressive dementia naturally raises questions about the long list of ex-athletes who've demonstrated aberrant and sometimes criminal behaviour. The public typically dismisses these as the antics of overgrown adolescents and thugs. But does that fully explain the repeated criminal relapses of notorious ex-boxer Mike Tyson? What about the tragic demise of former NHL pugilist John Kordic, who died in a violent struggle with police in Quebec in 1992? What about O.J. Simpson? Could his spiral into bizarre criminality be evidence of degenerative brain damage?

"Neither medicine nor science can fully explain all the differences in the way different people react to brain injuries," Bailes says. "With O.J. Simpson, what you can say with certainty is he played for many years in which he would have received multiple serious impacts to the head. We know that after a successful latency period, he's manifesting bizarre behaviour. There's a pattern there. But the unfortunate thing about this disease is you can only have a conclusive diagnosis after a person dies and you can look at their brain microscopically."

Diagnosing the mechanics behind brain damage is hard enough, but it may be that effecting change is the most daunting task of all. After all, there's more than health at stake in this debate. There's the long-standing culture of sports to deal with. And, of course, the most powerful motivator of all: money.

Last month, Philadelphia Flyers rookie forward Steve Downie had just been knocked into the boards when he picked himself up and began looking for payback. A few seconds later, when Downie jumped up in full stride and launched his body like a human torpedo at Dean McAmmond's head, the Ottawa forward never saw what hit him. McAmmond was carted out on a stretcher and in a neck brace that night, for the second time in less than a year. A week later, Downie had been suspended for 20 games, but there's no timeline for McAmmond's return. Such is the unpredictable nature of concussions.

What we do know is that the NHL already has a long list of stars who've retired early due to unshakable concussion symptoms: Pat LaFontaine, Brett Lindros, Keith Primeau, Adam Deadmarsh, to name just a few. Other sports have their victims too: Steve Young, Troy Aikman and Ted Johnson all walked away from football early. Then there are the countless boxers, and wrestlers like Calgary's Bret Hart, whose careers ended in a fog of headaches, dizziness and nausea.

Last season, NHL players lost 760 games to concussion injuries, up 41 per cent from a year earlier. A casual observer might expect that such staggering numbers would trigger a crackdown on debilitating hits. But late last season, the league's top disciplinarian, Colin Campbell, summed up the league's position: "If we eliminate all hits to the upper body, what's left? Hits to the belly button? We can't forget we are a physical game."

To critics like Tator, that attitude is as shortsighted as it is irresponsible. "Downie's hit was ridiculous. It was a flagrant example of everything we don't want to happen," Tator says. "There are things we can do to prevent that - why do we allow hits to the head in hockey? They do it because they think it's commercially positive, that those kinds of hits put people in the seats. They want hits to the head."

As unsettling as it may be to Tator and the others, the NHL knows what sells. Whether or not we like to admit it, the element of danger and the risk of injury are integral to the appeal of contact sports. That's why fierce hits make the nightly highlight reels, and why fans jump to their feet when two bruisers drop the gloves. But if the NHL represents the kind of old-school traditionalism that defends the status quo, the WWE's outright hostility toward Dr. Omalu's findings provides an indication of just how ugly this fight is likely to get before it's over.

A few days after Chris Benoit's death, the WWE held a televised tribute to its fallen star. But a week after the Sports Legacy Institute released its results, the WWE received a letter from a Benoit family lawyer advising the company not to discard any health records, as they may be evidence in a possible lawsuit. With that, the days of venerating Benoit's memory came to an abrupt halt.

Jerry McDevitt is the outside counsel for the WWE and says the company has asked for the science behind Omalu's tests to be turned over so it can be reviewed by others in the field. Until that happens "we're not going to dignify the crap they're peddling," he says. McDevitt refused to comment on reports that Benoit suffered head injuries in the ring, and declined to discuss any plans the WWE might have to mitigate the risk of such injuries in the future. And any suggestion that the WWE might bear some responsibility for what happened to the Benoit family gets McDevitt steamed. "The entire notion that the WWE could be sued because Chris Benoit garrotted his wife and killed his son is absurd in the extreme, legally and factually, whether he had concussions or whether he didn't," he says. "People get concussions every day in sports, and nobody goes out and kills their wife and child. It's no excuse for murder. Give me a break. Everybody knows it's not a side effect of concussions that you commit murder, for Christ's sake."

The problem with that, of course, is that mental incapacity is in fact a defence for murder. As for what everybody knows - that consensus may be changing.

For years the NFL resisted calls to take a more conservative approach on concussions. The league's concussion committee came under withering criticism for guidelines and public statements that seemed to fly in the face of established brain science. This year, Dr. Elliot Pellman stepped down after 12 years as head of the concussion committee and new NFL commissioner Roger Goodell unveiled tougher new guidelines for dealing with head injuries. "At no time should competitive issues override medical issues," Goodell said. "Safety comes first." It was a huge step, but there are already signs that a new policy won't be enough to really change the culture. In the second week of the season, Detroit Lions' quarterback Jon Kitna was knocked senseless in the second quarter and had to leave the game. But he was allowed to return in the fourth quarter, and led his team to victory. Team officials said after about an hour of rest, Kitna appeared to have recovered. Kitna credited the hand of God with clearing his head and guiding him back into action.

On the day his life changed forever, Michael Benoit left his job as a manager at a manufacturing business near Edmonton as usual, and started the drive to his house outside the city. As he approached the house, he saw his wife waiting at the foot of their long driveway with Chris's friend, Scott Zerr. As he approached, his cellphone rang. It was his cousin from Ottawa. "Is it true what they're saying about Chris?" he asked. Benoit didn't understand. He rolled down his window, and Zerr said simply "He's gone."

For the next 24 hours, Benoit couldn't pull himself away from the television. He watched, shattered and bewildered, as news reports recounted the sketchy details. He didn't recognize the monster they were describing. "I just kept sitting there, waiting for someone to say something nice about my son, to say something that I would recognize." That satisfaction never came.

It would be several days before he would begin to piece together the clues to what happened. First there were his son's journal entries - open letters to his dead friend Eddie Guerrero, a fellow wrestler who died in his sleep in a Minnesota hotel in 2005. The entries paint the picture of a man slowly losing his grip on reality, Benoit says. Chris had never been particularly religious, but the diary entries quote Scripture, and describe disturbing dreams in which he imagined people were after him, trying to steal his Bible. At times he seems to be pleading with his dead friend for help to sort out the images racing through his mind. "If I could have read these things when he was alive, it would have been clear. Here was a guy who needed help," he says.

When Chris Nowinski called and asked for permission to examine his son's brain tissue, Benoit was cautious. But as soon as he began to describe the breakdowns that led Strzelczyk, Long and Waters to kill themselves, the decision was clear. "I was grasping at straws at that point, but I knew in my heart that was the answer," he says. He had often talked to Chris about his injuries and asked him why he took such risks in the ring - getting hit in the head with chairs, sent crashing into steel barriers and wooden tables. "He said, 'I have to do it or I don't have a job.' So you jump off that riser and get hit in the head with that chair, and you don't say anything."

Bret Hart, perhaps Canada's most famous and successful wrestler, knows all about those pressures. He has just released an autobiography that paints a devastating picture of life in the WWE - an existence fuelled by steroids, painkillers, muscle relaxants and sleeping pills to cope with the relentless schedule and constant aches. His own career was ended by a serious concussion suffered in the ring, and looking back at dozens of his colleagues and friends who've died in recent years - overdoses, suicides, and heart attacks being the most common causes - he has no doubt that head injuries played a role in the depression and addictions that have claimed so many lives. The business "chews people up and spits them out," Hart says, and it's high time that wrestlers banded together to demand safer working conditions, better medical care and greater control over their careers.

Michael Benoit is determined to see that happen. "The WWE has to take responsibility for what's happening to their people," he says. "Their fingerprints are all over this." But there's a lot more at stake than just holding one company accountable, he says. It's about that universal desire of grieving parents, to find some meaning in death.

"Something good needs to come of this. You've got kids out there playing hockey and football, they get hit in the head and coaches who have no idea what a concussion means are saying 'you're just dinged, get back in there.' I think about all these soldiers coming back from Iraq and Afghanistan, all the bombs going off, these guys are suffering concussions. They need to know how serious that can be. I want to make it safer for all the boys that are left. Why should they suffer the same fate as my son?"

Maclean's October 22, 2007